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Patients undergoing cardiac surgery are at high risk for postoperative delirium, which is associated with longer hospital and intensive care lengths of stays, increased morbidity and mortality. Because sleep disturbances are common in delirium, melatonin has been an area of interest in the treatment of delirium. The rs10830963 single nucleotide polymorphism of the  melatonin receptor 1B  gene can cause pathological dysfunction of this receptor and is associated with delayed morning offset of melatonin. We hypothesized patients undergoing aortic cardiac surgery who have the risk genotype of a  melatonin receptor 1B  polymorphism would have a higher incidence of postoperative delirium.    Methods  Ninety-eight patients undergoing aortic root or valve surgery underwent analysis for  melatonin receptor 1B  single nucleotide polymorphism, rs10830963. Using a validated method, CHART-DEL, all charts were retrospectively reviewed and scored for the presence of delirium while blinded to the results of the  melatonin receptor 1B  gene polymorphism.    Results  Genotyping for  melatonin receptor 1B  polymorphism was acceptable in 76 subjects of European descent of which 18 (23.7%) had delirium. Four of seven subjects with the risk genotype had delirium versus only 20.3% of subjects without the risk genotype. This carried an odds ratio of 5.2 (1.0, 26.1), p = 0.050.    Conclusion  This observation suggests a role of the risk genotype of a  melatonin receptor 1B  polymorphism in the development of postoperative delirium. These hypotheses generating results warrant further prospective studies in a larger cohort group with delirium, circadian rhythm and melatonin assessments.

Does the melatonin receptor 1B gene polymorphism have a role in postoperative delirium?